Hundreds of West Virginians died last year from drug overdoses, at a rate higher than any other state and nearly twice the national average. Deaths have declined from pandemic highs, but remain close to pre-2020 levels.
Under state law, several effective tools to treat the opioid epidemic are tightly constrained. During this year’s legislative session, lawmakers largely left these restrictions in place.
These laws have made it harder for people with substance use disorder to get clean needles, access medication and enter drug treatment.
Entering this legislative session, the state’s drug czar, Dr. Stephen Loyd, and others said West Virginia needs juvenile drug treatment.
But a law limiting the number of treatment beds in each county stands in the way.
“I have two teenage daughters,” said Josh Barker, who leads the Attorney General’s Office’s opioid epidemic effort and is in recovery himself. “If they got hooked on drugs, I have no place to send them in this state.”
Barker said there are some programs for youth who are already deeply entangled with the legal system. But if a kid with substance use disorder decides to get treatment, they have to go to Pennsylvania, North Carolina or Utah.
In 2023, Wood County Republicans in the statehouse pushed to cap the number of treatment beds per county, arguing that the county didn’t have the resources to help people stay in recovery after completing treatment.
An Ohio company has plans to build a juvenile treatment facility in Cabell County. But the county already has the maximum number of beds. Rather than lift the cap entirely, lawmakers are moving legislation to allow the addition of 100 youth treatment beds statewide.
“We have a lot of youth in West Virginia who need services like this,” said Sen. Scott Fuller, a Republican from Wayne County and the lead sponsor. “And unfortunately, that wasn’t thought about a whole lot when the decision was made to limit beds in counties.”
The Senate Health Committee passed the juvenile drug treatment legislation. It is now in the House.
Sen. Brian Helton, a Republican from Fayette County who chairs the health committee, said they focused this session on legislation to make funding for drug treatment providers dependent on performance.
He said the change will make sure “our people aren’t getting put through programs in a revolving door method and then kicked right back out on the street when Medicaid runs out.”
“We want providers to step up and start providing wraparound services,” Helton said.
This approach has shown potential to improve medical care and lower costs. It’s funded in the budget passed by lawmakers last week.
The legislation is in line with a broad effort by Loyd and the state Office of Drug Control Policy to use data to improve the response, such as figuring out how much Narcan needs to be distributed in a particular county to reduce overdoses.
Last year, Loyd said more access to methadone is needed right away.
“I have absolutely screamed my lungs out here,” he said in an interview.
West Virginia is the only state in the nation with a moratorium on new methadone clinics, a medication that scientists say is more effective for people addicted to fentanyl. The powerful street drug is deadlier than heroin and continues to drive the state’s overdose crisis.
In federal court on Thursday, the state’s largest harm reduction group sued over the methadone moratorium, arguing it violates federal law and should be nullified.
In an emailed statement, West Virginia Department of Health spokesperson Gailyn Markham said the state has had concerns about methadone clinics in the past and believes any changes should be made by the Legislature, not in a courtroom.
The House Health Committee didn’t take up legislation to repeal the ban on new methadone clinics proposed by Del. Mike Pushkin, D-Kanawha. The committee’s chair, Del. Evan Worrell, R-Cabell, wouldn’t answer questions about restricting tools to combat the opioid epidemic.
“We do not need any more methadone clinics in West Virginia,” said Helton, adding that the state’s restrictions on syringe exchanges would be something for the Senate to look at next year.
Research shows syringe exchange programs are effective at reducing needle litter and slowing infectious diseases spread through needles.
Five years ago, lawmakers passed legislation creating many requirements on how programs can operate and who can use them.
Since the 2021 law, several syringe service programs in the state have closed.
“Some of the most effective tools that we have to address the ongoing opioid epidemic are being withheld from the people who want to offer them,” said Lake Sidikman, harm reduction program coordinator at the Women’s Health Center, which tried unsuccessfully to open a syringe service program in 2023.
This year, House lawmakers briefly considered banning syringe exchange programs entirely but decided not to.
Under political pressure and a lack of donor support, the Cabell-Huntington Health Department decided late last year to no longer offer syringes. In 2025, the program distributed nearly half of all clean needles in the state.
The health department still distributes naloxone, tests for diseases and refers people to treatment. But without clean syringes, the number of people coming to the program has been cut in half, said Dr. Michael Kilkenny, health officer and chief executive officer.
He said it’s encouraging that they haven’t seen a larger drop off. But people are having trouble finding clean needles, making it more likely they share needles, which can spread HIV.
“We’re at risk of another large outbreak, and syringe service programs are very, very effective in reducing the spread,” he said.
“More treatment is better,” he added. “More prevention is better.”